Sue Kelly Dermatology, LLC

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

DO00604 Issued in RI

Legal business name

SUE KELLY DERMATOLOGY, LLC

Practice address

7 Weaver Rd
North Kingstown, RI 02852-7135

Phone

(401) 667-0905

NPI assigned

Dec 3, 2007

Last updated

Jul 7, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan Christine Kelly, D.O.NPI 1548200074

Title

Physician

Phone

(401) 667-0905

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan C Kelly, D.O.

  • Dermatopathology Physician
  • North Kingstown, RI
  • NPI 1548200074
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1851573760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 WEAVER RD",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028527135",
            "telephone_number": "401-667-0905",
            "fax_number": "401-667-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 WEAVER RD",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028527135",
            "telephone_number": "401-667-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUE KELLY DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "401-667-0905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "RI",
            "license": "DO00604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Justine Stroble, RN
• Lora Struzik, PTA
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• Alexandra Dipietro Szabo
• Susan Elizabeth Taft, M.D.
• Matthew Tanner

• Dermatopathology Physician in North Kingstown, RI
• Providers in North Kingstown, RI by specialty
• Dermatopathology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.